Kokosis George, Perez Alexander, Pappas Theodore N
George Kokosis, Alexander Perez, Theodore N Pappas, Department of Surgery, Duke University Medical Center, Durham, NC 27705, United States.
World J Gastroenterol. 2014 Nov 21;20(43):16106-12. doi: 10.3748/wjg.v20.i43.16106.
Necrotizing pancreatitis is an uncommon yet serious complication of acute pancreatitis with mortality rates reported up to 15% that reach 30% in case of infection. Traditionally open surgical debridement was the only tool in our disposal to manage this serious clinical entity. This approach is however associated with poor outcomes. Management has now shifted away from open surgical debridement to a more conservative management and minimally invasive approaches. Contemporary approach to patients with necrotizing pancreatitis and/or infectious pancreatitis is summarized in the 3Ds: Delay, Drain and Debride. Patients can be managed in the intensive care unit and any intervention should be delayed. Percutaneous drainage can be utilized first and early in the course of the disease, followed by endoscopic drainage or video assisted retroperitoneoscopic drainage if necrosectomy is deemed necessary. Open surgery is now less frequently performed and should be reserved for cases refractory to any other approach. The management of necrotizing pancreatitis therefore requires a multidisciplinary dynamic model of approach rather than being a surgical disease.
坏死性胰腺炎是急性胰腺炎一种罕见但严重的并发症，据报道其死亡率高达15%，若发生感染则死亡率可达30%。传统上，开放手术清创是我们处理这一严重临床病症的唯一手段。然而，这种方法的治疗效果不佳。目前的治疗方式已从开放手术清创转向更为保守的治疗方法和微创方法。坏死性胰腺炎和/或感染性胰腺炎患者的现代治疗方法可概括为3D原则：延迟、引流和清创。患者可在重症监护病房进行治疗，任何干预措施都应延迟实施。在疾病进程早期可首先采用经皮引流，若认为有必要进行坏死组织清除术，则随后可采用内镜引流或视频辅助腹膜后腹腔镜引流。现在开放手术的实施频率较低，应仅用于对其他任何治疗方法均无效的病例。因此，坏死性胰腺炎的治疗需要多学科动态治疗模式，而不应仅被视为一种外科疾病。
